Use of High Risk Medications in the Elderly (DAE) Contents OVERVIEW ................................................................................................................................................. 1 TECHNICAL SPECIFICATIONS ...................................................................................................................... 3 APPENDIX 1 ................................................................................................................................................ 5 OVERVIEW Measure Description The percentage of patients 65 years of age and older who received at least one high-risk medication. The percentage of patients 65 years of age and older who received at least two different high-risk medications. Deviations from HEDIS Specifications The denominator from the third-party specifications includes beneficiaries who have “continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the measurement year.” The common enrollment specifications (and exclusion of 2010 part year beneficiaries) mean that all beneficiaries in the denominator will have enrollment for all of 2010. Also, the allowed gap of 45 days for HEDIS specs is different from the one-month gap allowed in our specs. The third-party specifications do not specify the setting for the NDC codes, but there are no NDC codes on claims other than Part D so we will only be searching in Part D claims. Assumptions/Notes The eligible population for this measure is based on discharges, not patients. This differs from how the eligible population is defined for other performance measures. It is possible for the denominator to contain multiple discharge records for the same individual. Data Sources Denominator inclusion data: 2010 Part A file 2010 Part B file 2010 Part D file Denominator exclusion data: None Numerator inclusion data: 2010 Part D file 1 Denominator Beneficiaries are included in the denominator if the following criteria are met: 65 years and older as of December 31 of the measurement year Continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year Enrolled as of December 31 of the measurement Denominator Exclusions None Numerator Beneficiaries are included if the beneficiary meets the following criteria: Numerator 1: At least one prescription dispensed for any high-risk medication during the measurement year. Numerator 2: At least two prescriptions dispensed for different high-risk medications during the measurement year. Rate Calculations For both rates, a lower rate represents better performance. 2 TECHNICAL SPECIFICATIONS Denominator The eligible population of beneficiaries who were a) 65 years and older as of December 31 of the measurement year and b) have continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. Note that the patient must be enrolled as of December 31 of the measurement year. A. For each beneficiaryi attributed to providerk use the enrollment arrays created in the enrollment pre- processing program and create NCQA_HRME_DENi = 1 if: 1. 65 <= Years between BENE_DOB and 12/31/2010 and The sum of the Part A, B, and D enrollment flags in each month of 2010 is less than 3 in no more than one month. The sum of the flags in December 2010 must be equal to 3. Denominator Exclusions None. Numerator Numerator 1 - At least one prescription dispensed for any high-risk medication (Table DAE-A) during the measurement year. Identify different drugs using the Drug ID field located in the NDC list on NCQA’s Web site (www.ncqa.org). NCQA provided a comprehensive list of medications and NDC codes to www.ncqa.org on November 15, 2010. Please see the Excel file Table DAE-A - Use of High-Risk Medications in the Elderly (DAE).xls for the list of NDCs to use. A. For each beneficiary i, create NCQA_HRME1_NUMi variable B. Search the 2010 Part D File and flag beneficiaries for inclusion in the numerator. 1. NCQA_HRME1_NUMi = 1 if 2. At least one of the following occurred between 1/1/2010 and 12/31/2010 for beneficiaryi in the 2010 Part D File where NCQA_HRME_DENi = 1: Description Variable Values/Rule Label Name (Unless otherwise noted, only require one {n} to equal the value) NDC Product service ID: High-Risk Medications – DAE_IIB2_NDC_A_11 short sas name = See Appendix 1 DAE_IIB2_NDC_B_11 PRDSRVID, long sas DAE_IIB2_NDC_C_11 name = PROD_SRVC_ID C. Else NCQA_HRME1_NUMi = 0 3 Numerator 2 - At least two prescriptions dispensed for different high-risk medications (Table DAE-A) during the measurement year. D. For each beneficiary i, create NCQA_HRME2_NUMi variable E. Search the 2010 Part D File and flag beneficiaries for inclusion in the numerator. 1. NCQA_HRME2_NUMi = 1 if 2. At least two of the following occurred between 1/1/2010 and 12/31/2010 for beneficiaryi in the 2010 Part D File where NCQA_HRME_DENi = 1: Description Variable Values/Rule (Unless otherwise noted, only require one Name {n} to equal the value) NDC Product service ID: High-Risk Medications – See Appendix 1 short sas name = PRDSRVID, long sas name = PROD_SRVC_ID Else NCQA_HRME2_NUMi = 0 Provider Performance Measure A. For each providerk, create NCQA_HRME1_RATEk = (∑NCQA_HRME1_NUMi/∑NCQA_HRME1_DENi)*100 B. For each providerk, create NCQA_HRME2_RATEk = (∑NCQA_HRME2_NUMi/∑NCQA_HRME2_DENi)*100 4 APPENDIX 1 Use of High Risk Medications in the Elderly (DAE) Numerator Beneficiaries from the 2010 Part D file with at least one prescription for a high-risk medication: NDC Codes 00002035302 propoxyphene napsylate 100 mg oral tablet 00002035303 propoxyphene napsylate 100 mg oral tablet 00002035333 propoxyphene napsylate 100 mg oral tablet 00002080302 propoxyphene hydrochloride 65 mg oral capsule 00002080303 propoxyphene hydrochloride 65 mg oral capsule 00002080333 propoxyphene hydrochloride 65 mg oral capsule 00002311102 ASA/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule 00002311103 ASA/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule 00006006268 cyproheptadine 4 mg oral tablet 00006093128 cyclobenzaprine 10 mg oral tablet 00007351220 dextroamphetamine 5 mg oral capsule, extended release 00007351259 dextroamphetamine 5 mg oral capsule, extended release 00007351320 dextroamphetamine 10 mg oral capsule, extended release 00007351359 dextroamphetamine 10 mg oral capsule, extended release 00007351420 dextroamphetamine 15 mg oral capsule, extended release 00007351459 dextroamphetamine 15 mg oral capsule, extended release 00007351920 dextroamphetamine 5 mg oral tablet 00008002702 promethazine 25 mg oral tablet 00008025901 meperidine 100 mg/mL injectable solution 00009002401 benzphetamine 50 mg oral tablet 00009002402 benzphetamine 50 mg oral tablet 00009377201 estropipate 0.75 mg oral tablet 00009377301 estropipate 1.5 mg oral tablet 00009377401 estropipate 3 mg oral tablet 00009377417 estropipate 3 mg oral tablet 00024033206 meperidine 50 mg/5 mL oral syrup 00024033502 meperidine 50 mg oral tablet 00024033504 meperidine 50 mg oral tablet 00024033506 meperidine 50 mg oral tablet 00024033704 meperidine 100 mg oral tablet 00024193704 acetaminophen-pentazocine 650 mg-25 mg oral tablet 00024195104 naloxone-pentazocine 0.5 mg-50 mg oral tablet 5 00025006131 atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet 00025006151 atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet 00025006152 atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet 00025006155 atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet 00025006602 atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid 00029280030 esterified estrogens 0.3 mg oral tablet 00031224713 diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid 00031742963 methocarbamol 500 mg oral tablet 00031744963 methocarbamol 750 mg oral tablet 00031744970 methocarbamol 750 mg oral tablet 00031869812 diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid 00031869813 diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid 00031870112 diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid 00031871512 diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral 00032102301 tablet esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral 00032102601 tablet esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral 00032102610 tablet 00037011016 butabarbital 30 mg/5 mL oral elixir 00037011360 butabarbital 30 mg oral tablet 00037011380 butabarbital 30 mg oral tablet 00037011460 butabarbital 50 mg oral tablet atropine/hyoscyamine/PB/scopolamine 0.0194 mg-0.1037 mg- 00037030192 16.2 mg-0.0065 mg oral tablet 00037200101 carisoprodol 350 mg oral tablet 00037200103 carisoprodol 350 mg oral tablet 00037210301 aspirin-carisoprodol 325 mg-200 mg oral tablet 00037225010 carisoprodol 250 mg oral tablet 00037225030 carisoprodol 250 mg oral tablet 00037240301 ASA/carisoprodol/codeine oral tablet APAP/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 00043046008 mL oral syrup diphenhydrAMINE-phenylephrine 6.25 mg-6.25 mg/5 mL oral 00043620404 liquid diphenhydrAMINE-phenylephrine 6.25 mg-6.25 mg/5 mL oral 00043620408 liquid APAP/diphenhydrAMINE/phenylephrine 650 mg-25 mg-10 mg oral 00043625606 powder for reconstitution APAP/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 00043626508 mL oral syrup 00045018210 acetaminophen-diphenhydrAMINE